TOP TALKER: THE PROBLEM WITH THE RUC— The WSJ goes inside the Relative Value Scale Update Committee, which doles out billions of Medicare dollars. “The RUC, as it is known, has stoked a debate over whether doctors have too much control over the flow of taxpayer dollars in the $500 billion Medicare program. Its critics fault the committee for contributing to a system that spends too much money on sophisticated procedures, while shorting the type of nuts-and-bolts primary care that could keep patients healthier from the start—and save money” The story http://bit.ly/aYALaZ

Good Wednesday morning. Six days until Election Day.

“Hypodermics on the shores, China's under martial law, Rock and Roller cola wars, Pulse can't take it anymore.”

Pulse marks the final week before the election with a rundown of the health themes that have dominated this cycle:

PULSE POLITICAL LANDSCAPE: THE CANDIDATES WHO TRIPPED OVER HEALTH— Several pols have had trouble navigating the choppy waters of health reform, careful to embrace the idea of reforming the system (which is popular) but not be caught fully supporting the law (which has not become much more popular since passage). Still more difficult is, if a candidate supports repeal, figuring out which pieces of the Democrats’ plan to keep. It’s forced several candidates to backtrack or their campaigns to issue “clarifying” statements.

-- The most recent example is W.Va. Gov. Joe Manchin, who tried to settle the situation with a statement on “Fox News Sunday” clarifying that he wouldn’t have supported the law, like he did in March, if he knew everything that was in it. But some say he only opened himself up to more criticism that he’s a party-line guy. “I think he opened himself up to a lot of legitimate questions as to: Are you going to follow your gut and principals when times get tough, or give your vote over to some leadership team?” says Michael Franc, vice president of government relations at the conservative Heritage Foundation.

-- FWIW, a recent Public Policy Polling poll shows that he’s expanding his lead to 50-44 over John Raese.

-- In Florida, Marco Rubio accused Charlie Crist of taking “six different positions” on the health law. PolitiFact spells them all out, but concludes that really he’s only taken three: he’s for it, he’s for fixing it and he would have opposed it. http://bit.ly/azqs56

HAPPENING TODAY— Rep. Chris Van Hollen hosts more than 150 people in Rockville, Md., at a symposium to discuss the benefits of the health care overhaul and local implementation.

OUTSIDE MEDICAL GROUPS ARE SPENDING FOR HECK— Joe Heck, the osteopathic physician and Republican running to replace Rep. Dina Titus in Nevada, is getting a heck of a lot of support from outside medical PACs this week.

--THE SPENDERS— The American Osteopathic Information Association-Osteopathic PAC is out with $62,000 in radio ads in support of his candidacy, according to FEC filings. The National Emergency Medicine PAC is spending another $58,000 on the radio and the American Congress of OB-GYNs PAC has dropped $18,010 in radio spots. All the filings were made just in the last two days.

ANTI ADS SLAMMED— Regulators and television stations have cracked down on dubious messaging in anti-health reform ads, ratcheting back some groups’ influence in the crucial pre-election week. The Connecticut FOX affiliate confirmed to PULSE that they pulled an American Action Network ad attacking Rep. Chris Murphy because it claimed health reform would jail those without insurance. The ad aired over the weekend and was pulled Monday night, FOX CT spokeswoman Andrea Savastra tells us. Over in Colorado, AAN voluntarily took down an ad on the local NBC affiliate, 9News, that claims Rep. Ed Perlmutter supported a health reform bill that would pay for Viagra for rapists. A 9News reporter had posted a fact check challenging the ad’s claims late Monday. Colorado ad http://bit.ly/cOrWw6 9News Fact Check http://bit.ly/a81FZc

This comes on the heels of the Ohio Election Commission blocking Susan B. Anthony List’s billboards, in Rep. Steve Driehaus’s district, over concerns of false messaging about the health reform law allowing government funding of abortion. The Ohio Election Commission has postponed an Oct. 28 hearing on the issue, a source familiar with the proceedings tells PULSE—meaning that the billboards are extremely unlikely to see the light of day.

--AAN RESPONDS— “This is all Democrat hyperventilation,” spokesman Jim Landry tells PULSE. “Out of respect to a station’s wishes, we changed four words to the Connecticut ad. The ad in Colorado ran throughout the weekend on multiple stations and is scheduled to conclude on Wednesday.” AAN posted a revised version of the Connecticut ad to its website late Tuesday, which now claims that the law has “penalties for not having coverage” New Connecticut Ad http://bit.ly/amShFj

--NOT ALL BAD NEWS— SBA List sees an upshot to their billboards being blocked: a debate over whether health reform allows for taxpayer funding of abortion. “It’s about whether or not there’s federal funding for abortion in health reform,” says spokeswoman Kerry Brown. “That’s a fight that we want to have.”

EXCLUSIVE: AHIP MAKES NEW HIRES— The insurance industry trade group has hired two new people in leadership roles: Joe Miller as general counsel and Daniel Durham as executive vice president for policy and regulatory affairs. “[A]s we restructure to meet the advocacy and policy needs of a new era in health care, AHIP has bolstered its senior leadership team with the additions of Joe Miller and Daniel Durham, two highly accomplished professionals who will be playing critical roles for us,” CEO Karen Ignagni wrote to member CEOs in a memo obtained by Pulse.

--Miller was in the antitrust division at Justice, where he was the assistant chief of the litigating section with responsibility for health care and insurance. Durham is the vice president for policy at PhRMA and has experience at HHS, OMB and the Social Security Administration.

HHS ANNOUNCES UP TO $335 MILLION IN GRANTS—HHS said Tuesday that existing community health centers are eligible to apply for additional funding under the health care reform law. The applications are due Jan. 6.

LET’S WRAP THIS UP – Consumer advocates are lobbying Sebelius to move the NAIC’s MLR recommendations forward untouched. “We urge you to resist requests from issuers to be exempted from the application of the legislation or for changes in the methodologies contained in the NAIC rule,” NAIC consumer advocates, lead by Timothy Jost, wrote to the HHS in a Tuesday letter. They also ask Sebelius not to change definitions, issue waivers with discretion or continue to count agent and broker commissions as administrative costs. The letter http://bit.ly/cYQHH1

FLIP-FLOPPERS FACE THEIR FUTURES— WaPo’s Aaron Blake’s observation: House Democrats who switched their vote to support health reform are doing a whole lot worse than those who flipped against the law. “Of those eight seats, Democrats are favored to hold just one after next Tuesday's election. Three or four of the other seven look to be lost causes, and the rest appear increasingly tough for Democrats. Meanwhile, there were five Democrats who flipped from 'yes' on the first bill to 'no' on final passage. And, by comparison, they're looking pretty good.” Full rundown http://wapo.st/9JQdXn

WHAT WE’RE READING:

Several national insurers have told the New Mexico insurance division that they will no longer write new plans in the individual and small group markets in the state, the New Mexico Independent reports. http://bit.ly/9Zc182

Health vote has put Democrats on the defensive, the NYT reports from Charlottesville, Va. http://nyti.ms/9DThG6

AHIP’s Karen Ignagni said Tuesday that major portions of the health law need to be retooled or it risks burying people and small businesses in rising health care costs. She made the remarks at the Nashville Health Care Council, as reported by the Nashville Business Journal. http://bit.ly/9LWZEq

The Medicare program is out of control and the reform law doesn’t so much to fix it, David Nather reports for the Center for Public Integrity. http://bit.ly/c05F9u

Join with national leaders to build consensus on the future of high-value health care delivery. Susan Dentzer, Editor-in-chief of Health Affairs, Dr. Richard Gilfillan, Acting Director of the new Center for Medicare and Medicaid Innovation (CMI) at the Centers for Medicare and Medicaid Services (CMS), and an outstanding group of panelists and moderators will be gathered to identify the next steps necessary to advance high-value health care delivery in America. The program aims to identify immediate issues to ensure the spread of high-value health care practices, formulate recommendations of innovative projects for the CMI and look to future phases of health care reform. Your experiences and ideas will help influence and form the solutions.